The Forked Path

I saw a psychiatrist today from the CMHT who was, like the case worker yesterday, a very nice and professional person. We talked about my current situation, the plans I have regarding DBT therapy, my imminent return to work and medication.

I explained that doctors have prescribed a wide range of medications over the years and yet I feel that none have produced any noticeable benefit. He explained that people of a normally sound mind who develop depression usually respond very well to antidepressants. However, individuals who have had depression for a long time may find that such medication has limited efficacy. In my case I have been suffering with depression since before the age of 10, so my frustration has a likely explanation now.

The psychiatrist noted that my Lithium prescription of 1000mg could be increased, potentially providing an improved mood. He also said that as a person ages an antidepressant that may have had a negligible effect in the past could actually produce a more positive result due to changes in physiology. He offered me the choice but I deferred to his judgement. In light of the fact that I am already on Lithium it made more sense to him to increase that. So after verifying that my recent Lithium level blood test  returned a measurement between .5 and .8 (it was .5) the psychiatrist increased my Lithium dose to 1200mg every night. 

I will pick up the prescription tomorrow and will see the the psychiatrist in 6 weeks to monitor any improvement. I sincerely hope it does, but knowing that the dose can be increased further is encouraging.

I was also informed that whilst the CMHT do not offer DBT they do offer Materialisation Based Therapy (MBT). It also seems that the CMHT have placed me on the waiting list – which came as a surprise. From what I have read so far the patient should ideally select the therapy they feel most comfortable with. I’m confused now. I need to do some more reading.

“Dialectical Behavior Therapy (DBT) and Mentalization-Based Treatment (MBT) are two approaches to the treatment of borderline personality disorder (BPD). While DBT has the most empirical support, MBT has a small but significant evidence base. Dialectical behavior therapy synthesizes behaviorism, mindfulness, and dialectics, while MBT is conceptually anchored in psychoanalysis, attachment theory, cognitive neuroscience, and developmental psychopathology.”

Mentalization and Dialectical Behavior Therapy.

Today’s was another positive consultation. I have considerably more more faith, compared to a few days ago, in the quality of service that the NHS can provide. If I liked hats I’d be eating mine.

The phone conversation with the HR manager of my employer also went well. We spoke about recent events – my departure from the private hospital, my convoluted quest for therapy, the full circle back to the CMHT where I am now receiving psychiatric support, and being one step away from private DBT.

My return to work was discussed, and whilst I suggested a phased return a week from Monday my employer requires me to see an occupational therapist before I can resume work. The plan is to arrange an appointment for next week if possible but it has been difficult for my employer to source an occupational therapist with the appropriate experience and skills for handling a case as complex as mine.

Fortunately, even though my absence has exceeded my employers policy of one month at full pay before being moved to Statutory Sick Pay they are prepared to continue full pay until I have at least seen the occupational therapist. Beyond that I don’t know. If I return in a phased manner I expect I’ll remain at full pay. If I return as a part time employee then I expect that my salary will be adjusted pro rata. I have no idea what will happen with regards to spending one day a week attending DBT when the course starts. I’m not thinking about it too much now. What I do know is that if it came to it I could reduce my working week to 3 days and still just about manage to pay the bills – but that will be very hard, and feel like going back over ten years!

My employer has been very supportive, yet paranoia thinks it’s only because they have to. 

This is probably my BPD doing the thinking.

Or is it?

Things have been getting much more complicated over the last few days. Stress and anxiety are threatening increased aggression. I need to fight them.

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